Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Regions for health case study: Turning Welsh legislation for sustainable development into everyday practice

In 1998, Wales became one of the first nations in the world to have a legal requirement in relation to sustainable development. The introduction of the Well-being of Future Generations (Wales) Act 2015 bolstered previous schemes, by providing an enabling framework for thinking and working differently, and embedding a Health in All Policies approach. With seven well-being goals which aim to make Wales a healthier place, where the social, economic, environmental and cultural well-being of Wales is improved, the Act impacts on public bodies, including local authorities, to make sure that when making their decisions they take into account the impact they could have on people's well-being, that they involve citizens, and they look to the future as well as focusing on the now. Wales also became one of the first nations in the world to establish a legislative link to the international SDGs.

A new report gives practical examples and case studies demonstrating how organizations can respond to the legislation. Informed by a review of the international evidence, the report makes five key recommendations for practical implementation of sustainable development principles.

Although the report reflects the Welsh public sector context, the findings can act as a go-to guide for any organization seeking to address global issues such as climate change, biodiversity and de-carbonization, as well as to implement the globally agreed Sustainable Development Goals (SDG). The report is positive about the Welsh legislative approach; suggesting it could make a significant and long-lasting difference to the people living in Wales, with the potential to set an example globally.

The presentation will provide examples on how this is translating into practical action for the Welsh NHS system change including collective action on a de-carbonization pathway and how staff and the wider public are being motivated and engaged to 'Be The Change'. to create a network of champions will be given.

Partnerships for public health between regional governments and academic institutions – status quo in European regions

The development of partnerships is described as an important tool for achieving goals in the 2030 Agenda for Sustainable Development. Partnerships between regional governments and academic institutions could be important for solving public health issues, as they are often complex, and both academic and practice-related knowledge is necessary. Such partnerships at the regional level might be especially important as many sub-national regions in Europe have considerable responsibility and power in decision-making on important areas such as prevention, health promotion, and health care. The overall aim of this project was to provide more knowledge about public health partnerships between regional governments and academic institutions in different regions within WHO’s Region for Health Network (RHN). Through a mixed methods research design, we wanted to identify and describe good examples of existing partnerships, and to investigate enabling factors, challenges, and lessons learned. Information on ongoing partnerships were collected by sending an electronical questionnaire to contact persons of the 43 members regions in the RHN. Based on the mapping, four regions were selected for group interviews with different stakeholders within regional universities and regional government. There were 31 regions (72%) who answered the questionnaire, and group interviews were carried out in Østfold (Norway), Varna (Bulgaria), Utrecht (the Netherlands), and Saskatchewan (Canada). In this presentation the results from the survey will be presented; describing the occurrence of partnerships, how public health partnerships are formalized and organized, important enablers, hindrances, how collaborations are carried out in practice, perceived benefits and successes, and experienced challenges.

Panelists: Klara Dokova

Faculty of Public Health, Medical University of Varna, Varna, Bulgaria

Contact: klaradokova@gmail.com

Liesbeth van Holten

Healthy urban living at Provincie Utrecht, Utrecht, Netherlands

Contact: liesbeth.van.holten@provincie-utrecht.nl

Cordell Neudorf

College of Medicine, University of Saskatchewan, Saskatoon, Canada

Contact: cory.neudorf@usask.ca

Anni Skipstein

Chief officer Public Health, Østfold county, Norway

Contact: annis@ostfoldfk.no

Localized aliphatic organic material on the surface of Ceres

Organic compounds occur in some chondritic meteorites, and their signatures on solar system bodies have been sought for decades. Spectral signatures of organics have not been unambiguously identified on the surfaces of asteroids, whereas they have been detected on cometary nuclei. Data returned by the Visible and InfraRed Mapping Spectrometer on board the Dawn spacecraft show a clear detection of an organic absorption feature at 3.4 micrometers on dwarf planet Ceres. This signature is characteristic of aliphatic organic matter and is mainly localized on a broad region of ~1000 square kilometers close to the ~50-kilometer Ernutet crater. The combined presence on Ceres of ammonia-bearing hydrated minerals, water ice, carbonates, salts, and organic material indicates a very complex chemical environment, suggesting favorable environments to prebiotic chemistry.

Pitted terrains on (1) Ceres and implications for shallow subsurface volatile distribution

Prior to the arrival of the Dawn spacecraft at Ceres, the dwarf planet was anticipated to be ice-rich. Searches for morphological features related to ice have been ongoing during Dawn's mission at Ceres. Here we report the identification of pitted terrains associated with fresh Cerean impact craters. The Cerean pitted terrains exhibit strong morphological similarities to pitted materials previously identified on Mars (where ice is implicated in pit development) and Vesta (where the presence of ice is debated). We employ numerical models to investigate the formation of pitted materials on Ceres and discuss the relative importance of water ice and other volatiles in pit development there. We conclude that water ice likely plays an important role in pit development on Ceres. Similar pitted terrains may be common in the asteroid belt and may be of interest to future missions motivated by both astrobiology and in situ resource utilization.

Distribution of phyllosilicates on the surface of Ceres

The dwarf planet Ceres is known to host phyllosilicate minerals at its surface, but their distribution and origin have not previously been determined. We used the spectrometer onboard the Dawn spacecraft to map their spatial distribution on the basis of diagnostic absorption features in the visible and near-infrared spectral range (0.25 to 5.0 micrometers). We found that magnesium- and ammonium-bearing minerals are ubiquitous across the surface. Variations in the strength of the absorption features are spatially correlated and indicate considerable variability in the relative abundance of the phyllosilicates, although their composition is fairly uniform. These data, along with the distinctive spectral properties of Ceres relative to other asteroids and carbonaceous meteorites, indicate that the phyllosilicates were formed endogenously by a globally widespread and extensive alteration process.

Spectroscopic characterization of mineralogy and its diversity across Vesta

The mineralogy of Vesta, based on data obtained by the Dawn spacecraft's visible and infrared spectrometer, is consistent with howardite-eucrite-diogenite meteorites. There are considerable regional and local variations across the asteroid: Spectrally distinct regions include the south-polar Rheasilvia basin, which displays a higher diogenitic component, and equatorial regions, which show a higher eucritic component. The lithologic distribution indicates a deeper diogenitic crust, exposed after excavation by the impact that formed Rheasilvia, and an upper eucritic crust. Evidence for mineralogical stratigraphic layering is observed on crater walls and in ejecta. This is broadly consistent with magma-ocean models, but spectral variability highlights local variations, which suggests that the crust can be a complex assemblage of eucritic basalts and pyroxene cumulates. Overall, Vesta mineralogy indicates a complex magmatic evolution that led to a differentiated crust and mantle.

[The elderly in the Italian traffic environment: analysis of mobility patterns and determinants for fatal outcomes]

Road traffic injuries among the elderly substantially differ from those seen in younger subjects in terms of crash mechanisms and injury profile. The study aimed at analysing road traffic injuries among subjects aged over 65 in terms of the magnitude of the problem, mobility patterns and risk factors for fatal outcomes. Mortality and morbidity rates for age groups (0-64; > or = 65) and for mobility pattern were computed annually from 1991-2005, based on the police reports of all road traffic crashes that occurred in Italy from 1991 to 2005. Crashes involving subjects aged over 65 were analysed through stepwise logistic regression with accident outcome (dead/ injured) as dependent variable and demographic, environmental, and crash factors as independent variables. A downward trend in mortality rates for road traffic injury among the elderly was registered: from 16.7 per 100,000 inhabitants in 1991 to 9.7 in 2005. On the contrary, the morbidity rates showed an 11% increase in the 15 years under analysis. When involved in a crash, an elderly aged over 85 had an almost four-fold risk of death compared to a subject aged 65-74 (OR 3.6; CI: 2.9-4.4). Older pedestrians were found to be the most vulnerable road users with a probability of dying for the impact 11 times that of car occupants (OR 10.9;CI: 7.9-15.1). A crash occurring among the elderly in the South of Italy appeared to lead to death to a greater extent than crashes occurring in the rest of Italy. Specific attention has to be paid to the elderly in the traffic environment: besides being more fragile, they are also considerably exposed to the traffic as vulnerable road users. Preventive interventions should target male elderly aged over 85, prioritizing interventions on pedestrians in the South of Italy.

Two cases of paraoccupational asthma due to toluene diisocyanate (TDI)

Two cases of paraoccupational asthma caused by toluene diisocyanate (TDI) are reported. The first patient was a metal worker in a machine shop situated near a factory producing polyurethane foam. Symptoms at work were not explainable by any specific exposure to irritants or allergens in the work site. As the patient recalled previous occasional work in the adjacent polyurethane factory with accompanying worsening of respiratory symptoms, a specific inhalation (SIC) test was performed with TDI, which confirmed the diagnosis of TDI asthma. The second case was a woman working part time as a secretary in the offices of her son's factory for varnishing wooden chairs. TDI was present in the products used in the varnishing shed. The SIC test confirmed the diagnosis of TDI asthma, despite the fact that the patient's job did not present risk of exposure to the substance. In both patients, symptoms disappeared when further exposure was avoided. These two cases confirm that paraoccupational exposure to TDI must be considered when evaluating patients with asthma not mediated by immunoglobulin E. They also suggest the need for more prospective studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI.